Underestimation of risk for large babies in rural and remote Australia: Time to change plasma glucose collection protocols.
Underestimation of risk for large babies in rural and remote Australia: Time to change plasma glucose collection protocols.
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低估澳大利亚农村和偏远地区大婴儿的风险：是时候改变血糖采集方案了
DOI：
10.1016/j.jcte.2020.100247
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发表时间：
2021-03
影响因子：
3
通讯作者：
Marley JV
中科院分区：
文献类型：
--
作者：
Jamieson EL;Spry EP;Kirke AB;Roxburgh C;Atkinson DN;Marley JV
在偏远的澳大利亚，由于检测样本不稳定，许多患有妊娠期糖尿病的女性被遗漏。FC管稳定血糖，但显著增加低风险女性的GDM诊断率。FC结果的调整降低了GDM，并改善了对大婴儿的风险评估。分析前糖酵解在口服葡萄糖耐量试验(OGTT)中导致对妊娠期糖尿病(GDM)的严重低估，从而导致巨大胎龄(LGA)婴儿的风险。这篇论文量化了糖酵解对确定澳大利亚农村和偏远队列中LGA风险的影响。对于495名女性，对室温氟化物-草酸盐(FLOX)试管的OGTT结果进行了算法校正，以估计糖酵解，与1)高血糖和不良妊娠结局(HAPO)研究方案(冰浆中的FLOX试管)和2)室温氟化物-柠檬酸盐(FC)试管相比。妊娠期糖尿病是由国际糖尿病和妊娠研究组协会(IADPSG)标准定义的。未校正和校正的OGTT与LGA预后相关。校正FC管使GDM的发生率从9.7%增加到44.6%。校正HAPO方案后，GDM发生率为27.7%，LGA风险的预测(RR 1.82，[1.11-2.99])较未校正的(RR 1.12，[0.51-2.47])有所改善。为了给FC管矫正(29.3%GDM；RR 1.81，[1.11-2.96])提供类似的结果，需要对IADPSG标准进行+0.2M/M/L调整。FC管在远程设置中为HAPO协议提供了一种实用的替代方案，但可以提供更高的血糖读数。修改IADPSG标准将减少被认为的“过度诊断”，并改善LGA风险评估。
In remote Australia, many women with GDM are missed due to test sample instability. FC tubes stabilise glucose but markedly increase GDM diagnosis in lower-risk women. Adjustment of FC results lowered GDM and improved risk-assessment for a large baby. Preanalytical glycolysis in oral glucose tolerance tests (OGTT) leads to substantial underestimation of gestational diabetes mellitus (GDM) and hence risk for large-for-gestational-age (LGA) babies. This paper quantified the impact of glycolysis on identification of LGA risk in a prospective rural and remote Australian cohort. For 495 women, OGTT results from room temperature fluoride-oxalate (FLOX) tubes were algorithmically corrected for estimated glycolysis compared to 1) the Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study protocol (FLOX tubes in ice-slurry); and 2) room temperature fluoride-citrate (FC) tubes. GDM was defined by International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria. Unadjusted and corrected OGTT were related to LGA outcome. Correction for FC tubes increased GDM incidence from 9.7% to 44.6%. After correction for HAPO protocol, GDM incidence was 27.7% and prediction of LGA risk (RR 1.82, [1.11–2.99]) improved compared to unadjusted rates (RR 1.12, [0.51–2.47]). To provide similar results for FC tube correction (29.3% GDM; RR 1.81, [1.11–2.96]) required + 0.2 mmol/L adjustment of IADPSG criteria. FC tubes present a practical alternative to the HAPO protocol in remote settings but give + 0.2 mmol/L higher glucose readings. Modification of IADPSG criteria would reduce perceived ‘overdiagnosis’ and improve LGA risk-assessment.
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影响因子：
3.9
作者：
Bogdanet D;O'Shea P;Lyons C;Shafat A;Dunne F
通讯作者：
Dunne F
影响因子：
3.1
作者：
Berntorp K;Anderberg E;Claesson R;Ignell C;Källén K
通讯作者：
Källén K
DOI：
10.1111/j.1471-0528.2009.02486.x
发表时间：
2010-04-01
影响因子：
5.8
作者：
Metzger, B. E.
通讯作者：
Metzger, B. E.
影响因子：
5.8
作者：
Retnakaran, Ravi;Qi, Ying;Zinman, Bernard
通讯作者：
Zinman, Bernard
影响因子：
158.5
作者：
Crowther, CA;Hiller, JE;Robinson, JS
通讯作者：
Robinson, JS